MANAGEMENT OF PATIENTS WITH HYPERTENSION AND ATRIAL FIBRILLATION PRESENTING TO THE EMERGENCY DEPARTMENT: PP.1.34

Abstract

Background: Management in the Emergency Department (ED) of patients (pts) with atrial fibrillation (AF) by the availability of new facilities including an Intensive Observation Unit (IOU) and an Outpatient Clinic (OC) could improve the global treatment strategy. Objective: To prevent admissions by the management with an IOU and an OC, in pts with hypertension and AF. Methods. We compared 2 groups of pts presenting to the ED with AF, when the new facilities were unavailable (Group A, 2006–2007), and after the ED reorganization (Group B, 2008–2009). We considered the clinical characteristics, the presence of mild to moderate comorbidities, the AF duration (hours) and the therapeutic approach (pharmacological or DC shock). Overall, 869 pts (38,8%) presented with hypertension and mild structural heart disease. Endpoint: Primary endpoint was prevention of admission; secondary end-point was detection of characteristic predictive of poor outcome. Results: We enrolled 2,237 pts (group A: 970 pts, age 70 y, 38% with hypertension; and group B: 1267 pts, age 71 y, 39,5% with hypertension; all p = n.s.). Admission rate was significantly reduced when IOU and OC were available (Group A, 38% vs Group B, 23%, p < 0,0001). Group A showed higher percentage of comorbidities (40%) vs Group B (24%; p < 0.0001), and pts with AF lasting >48 hours (43%) vs Group B (27%, p < 0.0001). However, when the presence of comorbidities, AF duration, and group assignment were considered comorbidities (HR: 11, CI:8–13; p < 0.0001) and AF duration > 48 hours (HR:5, CI: 4–6; p < 0.0001) were independent predictor of poor outcome. Hypertension, per se, was not associated with poor outcome or longer length of in-hospital stay. Finally, the new ED reorganization was associated with a better outcome (HR: 0.78, CI: 0.62–0.98; p = 0.035). Conclusions: A new ED organization with IOU and OC significantly reduces hospital admission independently of the presence of hypertension. Mild to moderate comorbidities and AF lasting > 48 hours are independent predictors of hospitalization.